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Maligne trachealtumoren — chirurgische Erfahrung bei 6 Patienten mit primären Malignomen der Trachea

Aktuelle Diagnostik und Therapie

Malignant tracheal tumours — surgical experience in six patients with primary tumours of the trachea

Current diagnosis and therapy

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Abstract

In a retrospective study six patients with malignant tumours of the trachea located distal to the cricoid and proximal to the carina tracheae were operated on during the period of December 1983 to July 1995 in the Department of Thoracic Surgery in Hannover (Heidehaus). Histopathological examination revealed two adenoid cystic carcinomas, two squamous cell carcinomas, one mucoepidermoid carcinoma, and one low-grade sarcoma. Laser bronchoscopic resection was performed in one patient and tracheotomy one other avoid imminent asphyxia. Physical examination mainly showed a range of symptoms such as stridor and dyspnoea; spirography showed increased airway resistance, and X-ray of the trachea was important in the diagnostic process. The tracheal tumours were diagnosed by histopathological examination of excised material obtained by bronchoscopy. Three patients underwent resection and primary reconstruction of the trachea, with a length of resection between 2.0 and 3.5 cm and end-to-end anastomosis. Endotracheal afterloading was necessary in the case of one female patient with tumour infiltration of the proximal end of the upper trachea. Neoadjuvant irradiation was followed by resection of the whole trachea and implantation of a tracheal prosthesis (Neville) in the case of a patient with extensive endo- and extraluminal tumour infiltration. An extensive recurrence led to the death of this patient 5 months after the surgical intervention. Because of the distal location, resection of the tracheal bifurcation was necessary in two patients, in one combined with a pneumonectomy on the right side. Stenosis of the main bronchus and development of granuloma made stent implantation unavoidable. Dislocation of the stents and recurrent pneumonia caused the patients deaths 74 days and 18 months postoperatively. On follow up 17, 93 and 120 months postoperatively none of the other patients had recurrences. Current diagnostic and therapeutic options for malignant tracheal tumours are discussed.

Zusammenfassung

Retrospektiv wurden 6 Patienten mit malignen Trachealtumoren im Bereich distal des Cricoids und proximal der Carina tracheae aus dem Zeitraum zwischen Dezember 1983 und Juli 1995 erfaßt. Dabei handelte es sich histopathologisch um 2 adenoid-zystische Karzinome, um 2 Plattenepithelkarzinome, um ein Mukoepidermoidkarzinom sowie um ein Low-grade-Sarkom. Bei 1 Patienten wurde aufgrund drohender Asphyxie durch Tumorobstruktion eine Tracheotomie, in einem weiteren Fall eine laserbronchoskopische Resektion unter Notfallbedingungen erforderlich. Diagnostisch hinweisend waren bei der klinischen Untersuchung Stridor und Belastungsdyspnoe, bei der Lungenfunktionsanalyse die Erhöhung der Atemwegsresistance und bei der Röntgendiagnostik die Tracheazielaufnahme. Die Diagnosesicherung erfolgte durch die histologische Untersuchung bronchoskopisch gewonnener Probeexzisionen. Bei 3 Patienten war sukzessive eine Tracheasegmentresektion mit einer Resektionslänge zwischen 2,0 und 3,5 cm und Anlage einer Endzu-End-Anastomose möglich. Aufgrund von Tumorausläufern im zentralen Resektionsrand wurde 1 Patientin mittels endotrachealem Afterloading nachbestrahlt. Bei 1 Patienten mit intra- und extramuraler Tumorinfiltration wurde nach neoadjuvanter Radiatio die Resektion der gesamten Trachea und die Implantation einer Neville-Trachealprothese erforderlich. Der Patient verstarb 5 Monate postoperativ infolge eines ausgedehnten Tumorrezidivs. Aufgrund der distalen Tumorlokalisation wurde bei 2 Patienten die Trachealbifurkation reseziert, in einem Fall verbunden mit einer rechtsseitigen Pneumonektomie. Eine Hauptbronchusstenose durch Granulombildung zwang bei beiden Patienten zu einer Stenteinlage. Rezidivierende Pneumonien durch Sekretverhaltung und Stentdislokation führten 74 Tage bzw. 18 Monate postoperativ zum Tode. 17, 93 und 120 Monate postoperativ waren die anderen Patienten rezidiv- und beschwerdefrei. Diskutiert werden aktuelle diagnostische und chirurgische Möglichkeiten einschließlich adjuvanter Therapiemaßnahmen beim Vorliegen eines malignen Trachealtumors.

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  1. Klinik für Thorax- und Gefäßchirurgie im Städtischen Krankenhaus Heidehaus, Am Leineufer 70, D-30419, Hannover

    M. Teschner

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Teschner, M. Maligne trachealtumoren — chirurgische Erfahrung bei 6 Patienten mit primären Malignomen der Trachea. Langenbecks Arch Chir 381, 23–33 (1996). https://doi.org/10.1007/BF00184251

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